11D2121170 CLIA NUMBER - KROGER PHARMACY #626

Laboratory Demographics

  • CLIA Code: 11D2121170
  • Facility Name: KROGER PHARMACY #626
  • Facility Address: 2452 MOROSGO WAY
    ATLANTA, GA
    ZIP 30324
  • Facility Phone: 404 946-0450
  • Facility Type: Other - RETAIL PHARMACY
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1780134403
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2121170
LAB Type Other - RETAIL PHARMACY
Facility Name KROGER PHARMACY #626
Street 2452 MOROSGO WAY
City ATLANTA
State GA
ZIP 30324
Phone 404 946-0450
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/1/2024
Certificate Expiration Date 10/31/2026
Facility Type Other - RETAIL PHARMACY
Lab Director CHUCK PAGE

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This page was last updated on: 9/29/2025